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2.
Nurs Outlook ; 67(6): 734-746, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31570146

RESUMO

BACKGROUND: Autonomy and meaningful work (MW) have both been positively related to work satisfaction for nurses, however, the relationship between the various forms of autonomy and MW is unclear. Both autonomy and MW are complex concepts, and it is important to understand how different forms of autonomy, such as individual, professional, and perceived group-based autonomy, influence different dimensions of MW such as Expressing Full Potential and Service to Others. It is critical to fully understand the autonomy/MW relationship, because this knowledge can serve as a basis for developing effective and efficient interventions. PURPOSE: The purpose of this paper is to better understand the relationship between autonomy and MW by examining the autonomy-MW framework. METHODS: Multilevel analyses using data from 510 nurses nested within four organizational divisions from three health care organizations were conducted. The Comprehensive Meaningful Works Scale was used to measure multiple dimensions of MW. FINDINGS: Our study demonstrated that individual and professional autonomy have significant positive relationships with six of the seven MW dimensions. Perceived group autonomy has significant positive, though weak, relationships with two dimensions of MW. DISCUSSION: Our results show that different forms of autonomy relate differently to the dimensions of MW and as such demonstrate that the relationship between autonomy and MW is not a simple input-output relationship. Our results show partial support for the autonomy-MW framework. Health care organizations that want to cultivate MW should not automatically implement autonomous teams but rather understand that a combination of autonomy practices could lead to MW.


Assuntos
Atitude do Pessoal de Saúde , Satisfação no Emprego , Papel do Profissional de Enfermagem/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Autonomia Pessoal , Autonomia Profissional , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
3.
Semin Vasc Surg ; 32(1-2): 14-17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540649

RESUMO

The recognition of vascular surgery as an independent surgical specialty is inevitable, but the pathway to full autonomy remains uncertain. Vascular surgery emerged from general surgery in the mid-1950s with the advent of synthetic grafts and microvascular techniques. By the early 1980s, Accreditation Council for Graduate Medical Education-approved fellowships were established in most large academic medical centers. The American Board of Surgery recognized this additional specialty training by awarding vascular graduates a Certificate of Special Qualifications distinguishing them from general surgeons. The emergence of endovascular surgery radically changed the face of vascular surgery from a general surgery subspecialty to a unique surgical specialty with a growing array of minimally invasive tools. With the establishment of a primary Certificate in Vascular Surgery and the subsequent development of integrated residencies, vascular surgery moved ever closer to recognition as an independent surgical specialty. Despite the remarkable progress that has been observed over the past 50 years, there is a desire in the vascular community for formal recognition of the unique body of knowledge and surgical skills that serve as the foundation of contemporary vascular care.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Autonomia Profissional , Conselhos de Especialidade Profissional , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina/história , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/tendências , Previsões , História do Século XX , História do Século XXI , Humanos , Conselhos de Especialidade Profissional/história , Conselhos de Especialidade Profissional/normas , Conselhos de Especialidade Profissional/tendências , Cirurgiões/história , Cirurgiões/normas , Cirurgiões/tendências , Estados Unidos , Procedimentos Cirúrgicos Vasculares/história , Procedimentos Cirúrgicos Vasculares/normas , Procedimentos Cirúrgicos Vasculares/tendências
4.
Lakartidningen ; 1162019 Aug 26.
Artigo em Sueco | MEDLINE | ID: mdl-31454053

RESUMO

The Swedish Association for Child and Adolescent Psychiatry conducted a survey among their specialty trainees in 2018. Of the 48% response rate, around 48% admitted hesitancy to continue in their chosen specialty. A further 12% planned to depart from their field after completion of training. Factors associated with discontinuation in training were the perception of ineffective psychotherapeutic treatments and a lack of autonomy at work; which was strongly correlated to the doctor's role and team collaboration. Workload was generally perceived as excessive, with not enough time for after work recovery and the subsequent negative impact on private life. However, these factors were not found to significantly affect trainees' decision to leave. The doctor's role requires better clarification and medical leadership needs to be improved, so that evidence based treatments can be offered.


Assuntos
Psiquiatria do Adolescente , Atitude do Pessoal de Saúde , Psiquiatria Infantil , Educação de Pós-Graduação em Medicina , Adolescente , Adulto , Escolha da Profissão , Criança , Orientação Infantil , Humanos , Papel do Médico , Autonomia Profissional , Psicoterapia/normas , Psicotrópicos/normas , Sociedades Médicas , Inquéritos e Questionários , Suécia , Equilíbrio Trabalho-Vida , Carga de Trabalho/psicologia , Local de Trabalho/psicologia
5.
BMC Med Educ ; 19(1): 293, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366383

RESUMO

BACKGROUND: Providing appropriate levels of autonomy to resident physicians is an important facet of graduate medical education, allowing learners to progress toward the ultimate goal of independent practice. While studies have identified the importance of autonomy to the development of resident physicians, less is known about resident perspectives on their "lived experiences" with autonomy and ways in which clinical educators either promote or undermine it. The current study aims to provide an empirically based practical framework based on resident perspectives through which supervising physicians can attempt to more adequately foster resident physician autonomy. METHODS: Residents completed open ended surveys followed by facilitated group discussions of their perspectives on autonomy. Qualitative thematic analysis identified key themes in resident definitions of autonomy and how clinical educators either promote or undermine resident autonomy during supervision. Fifty-nine resident physicians representing six different specialties from two institutions participated. RESULTS: Learners felt that autonomy was critical to their development as independent physicians. Leading the approach to care, a sense of ownership for patients, and receiving appropriate levels of supervision were identified as key components of autonomy. Attending physicians who promoted this active involvement with patient care were felt to have a strong positive influence on resident autonomy. Autonomy was undermined when decisions were micromanaged and resident input in decision-making process was minimized. CONCLUSIONS: Fostering autonomy is a critical aspect of medical education. Allowing residents to take the lead in the delivery of patient care while supporting them as important members of the health care team can help to promote resident autonomy in the clinical setting.


Assuntos
Internato e Residência , Relações Interprofissionais , Autonomia Profissional , Competência Clínica , Médicos , Inquéritos e Questionários
6.
Artigo em Inglês | MEDLINE | ID: mdl-31323860

RESUMO

In this study, we examine employees' perceptions of their work ability from a sustainable career perspective. Specifically, we investigate the role of a person's perceived current fit (i.e., autonomy, strengths use and needs-supply fit), and future fit with their job as resources that affect perceived work ability, defined as the extent to which employees feel capable of continuing their current work over a longer time period. In addition, we test whether meaningfulness of one's work mediates this relationship, and we address the moderating role of age. Our hypotheses were tested using a sample of 5205 employees working in diverse sectors in Belgium. The results of multi-group Structural Equation Modelling (SEM) provide mixed evidence for our hypotheses. While all four resources were significantly and positively related to perceived meaningfulness, only needs-supply fit was positively related to perceived work ability. Strengths use, on the other hand, was also significantly related to perceived work ability, yet in a negative way. These findings underscore the importance of distinguishing between several types of resources to understand their impact upon perceived work ability. Interestingly, the relationship between future-orientedness of the job and perceived work ability was moderated by age, with the relationship only being significant and positive for middle-aged and senior workers. This suggests an increasingly important role of having a perspective of future fit with one's job as employees grow older. Contrary to our expectations, meaningfulness did not mediate the relationships between resources and perceived work ability. We discuss these findings and their implications from the perspective of sustainable career development.


Assuntos
Aptidão , Ocupações , Autonomia Profissional , Trabalho/psicologia , Adulto , Bélgica , Escolha da Profissão , Feminino , Recursos em Saúde , Humanos , Longevidade , Masculino , Pessoa de Meia-Idade , Recursos Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-31311126

RESUMO

The study has two objectives-first, to examine the dimensionality of police service employees' job satisfaction and their assessment of the enablers from the Common Assessment Framework, analyzing these facets at different organizational levels, and second, to identify the impact of selected facets of job satisfaction on trust in one's immediate leader. The study is based on a comprehensive on-line questionnaire where 1209 responses from police service employees were acquired, and for the data analysis, factor analysis was first used to formulate the factors of job satisfaction facets and of the Common Assessment Framework enablers. Second, structural equation modelling was performed to identify the correlations of the studied variables. The Common Assessment Framework enabler Strategy/Leadership was significantly correlated with the enabler Processes and had an indirect impact on Trust through direct impacts on Leadership style in the organizational unit and Autonomy/Tasks. Both of the latter determinants had a significant influence on Trust in one's immediate leader. The confirmed the impact of determinants from different hierarchical levels indicates the importance of efforts by managers at all organizational levels should the police management intend to achieve and maintain high levels of trust in one's immediate leader in police service work environment.


Assuntos
Satisfação no Emprego , Liderança , Polícia/psicologia , Confiança , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polícia/organização & administração , Autonomia Profissional , Eslovênia , Inquéritos e Questionários
8.
Nurse Educ Pract ; 38: 145-152, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31284217

RESUMO

Role competence and patient safety (PS) competence among healthcare professionals are rapidly developing issues due to increasing patient acuity and complexity in the healthcare system. Upon graduation, nurse practitioners (NP) provide autonomous healthcare for populations with complex health needs, thus role and PS competence is imperative. The study aim was to test a hypothesized model of the relationships between educational structural empowerment (SE), psychological empowerment (PE), NP role competence, and PS competence. The sample was drawn from newly graduated NPs from across Canada, accessed through twenty professional nurse organizations. The study survey included socio-demographic questions, the Conditions of Learning Effectiveness Questionnaire, the PE Scale, the NP Competence Survey, and the Health Processional Education in PS Survey. One hundred and ninety Canadian educated NPs who completed their studies in the preceding 2-year time period responded. The study model tested the effect of educational SE on NP role competence and PS competence partially mediated by PE. PE partially mediated the positive relationship for educational SE and PS competence, yet no mediation effect occurred for educational SE and NP role competence. Nurse educators need to consider educational SE strategies as NPs' positive perceptions of role competence have the potential to influence greater levels of PS competence.


Assuntos
Competência Clínica/normas , Adulto , Atitude do Pessoal de Saúde , Canadá , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem , Segurança do Paciente , Autonomia Profissional , Inquéritos e Questionários
9.
Implement Sci ; 14(1): 70, 2019 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286964

RESUMO

BACKGROUND: Many interventions used in health care lack evidence of effectiveness and may be unnecessary or even cause harm, and should therefore be de-implemented. Lists of such ineffective, low-value practices are common, but these lists have little chance of leading to improvements without sufficient knowledge regarding how de-implementation can be governed and carried out. However, decisions regarding de-implementation are not only a matter of scientific evidence; the puzzle is far more complex with political, economic, and relational interests play a role. This project aims at exploring the governance of de-implementation of low-value practices from the perspectives of national and regional governments and senior management at provider organizations. METHODS: Theories of complexity science and organizational alignment are used, and interviews are conducted with stakeholders involved in the governance of low-value practice de-implementation, including national and regional governments (focusing on two contrasting regions in Sweden) and senior management at provider organizations. In addition, an ongoing process for governing de-implementation in accordance with current recommendations is followed over an 18-month period to explore how governance is conducted in practice. A framework for the governance of de-implementation and policy suggestions will be developed to guide de-implementation governance. DISCUSSION: This study contributes to knowledge about the governance of de-implementation of low-value care practices. The study provides rich empirical data from multiple system levels regarding how de-implementation of low-value practices is currently governed. The study also makes a theoretical contribution by applying the theories of complexity and organizational alignment, which may provide generalizable knowledge about the interplay between stakeholders across system levels and how and why certain factors influence the governance of de-implementation. The project employs a solution-oriented perspective by developing a framework for de-implementation of low-value practices and suggesting practical strategies to improve the governance of de-implementation. The framework and strategies can thereafter be evaluated for validity and impact in future studies.


Assuntos
Tomada de Decisões , Assistência à Saúde/normas , Fechamento de Instituições de Saúde/métodos , Administração de Serviços de Saúde , Autonomia Profissional , Qualidade da Assistência à Saúde/normas , Humanos , Entrevistas como Assunto , Modelos Teóricos , Política Organizacional , Formulação de Políticas , Suécia
11.
Rev. enferm. UFSM ; 9: [19], jul. 15, 2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1024241

RESUMO

Objetivo: conhecer a percepção de enfermeiras obstetras sobre o modelo e prática assistencial em uma maternidade filantrópica. Método: estudo qualitativo com 13 enfermeiras obstetras que trabalham em uma maternidade mineira, coleta de dados de setembro de 2015 a fevereiro de 2016 por meio de entrevista semiestruturada, utilizando-se Análise de Conteúdo. Resultados: emergiram como categorias: Atuação pautada na humanização e nas boas práticas; Autonomia para atuar; Profissional de referência para tomada de decisões; Atuação em equipe e Modelo de atuação. Discussão: verificou-se que as enfermeiras atuam com autonomia em equipe, não nomeiam um modelo de assistência e apontam a demanda de serviço e o modelo tecnocrático como dificultadores. Considerações finais: apoio e suporte dos gestores são importantes para a atuação das profissionais, contribuindo para um trabalho autônomo. Apesar dos avanços, ainda há desafios a serem superados tanto no âmbito da equipe e comunicação, quanto do suporte dos gestores.


Objective: to identify the perception of obstetric nurses about the healthcare model and practice in a philanthropic maternity hospital. Method: qualitative study of 13 obstetric nurses working in a Minas Gerais maternity hospital. Researchers used semi-structured interviews for data collection which took place from September 2015 to February 2016. Data analysis used content analysis. Results: the following categories emerged: Performance based on humanization and good practices; Professional autonomy; Professional mentoring during decision making; Teamwork and Performance Model. Discussion: research revealed that nurses are autonomous and work as a team; they did not single out a healthcare model and identified work demand and technocratic model as obstacles. Final considerations: management support is important for the professionals' performance since it contributes to autonomy at work. Despite the progress made, there are still challenges both in terms of staff and communication, as well as management support


Objetivo: conocer la percepción de las enfermeras obstétricas sobre la práctica y el modelo de atención en una maternidad de beneficencia. Método: estudio cualitativo con 13 enfermeras obstétricas de una maternidad de Minas Gerais; los datos, recogidos de septiembre de 2015 a febrero de 2016 en entrevistas semiestructuradas, se analizaron según el análisis de contenido. Resultados: se identificaron las siguientes categorías: Desempeño basado en la humanización y en las buenas prácticas; Autonomía para trabajar; Coaching para la toma de decisiones; Trabajo en equipo y Modelo de desempeño. Discusión: las enfermeras actúan con autonomía, en equipo, no mencionaron ningún modelo de atención; la demanda de servicios y el modelo tecnocrático representaban obstáculos. Consideraciones finales: el respaldo de la gerencia es fundamental para el desempeño profesional y contribuye a que se trabaje con autonomía. Aún hay retos por superar, tanto a nivel de equipos y comunicación como de respaldo de la gerencia.


Assuntos
Humanos , Prática Profissional , Autonomia Profissional , Tocologia , Enfermagem Obstétrica
12.
Br Dent J ; 226(12): 955-962, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31253917

RESUMO

Background The aim of this study was to explore the experiences of dental associates and how these relate to their working environment.Methods Qualitative methodology was used. Semi-structured interviews were conducted with 11 associates in the UK in early 2018. Participants were asked about their working experiences, professional autonomy and the improvements they thought could be made to their working environment. Interview transcripts were analysed using deductive thematic analysis.Results Three key themes were identified: 1) 'conditions', how associates view their working environment; 2) 'drivers', what associates believe drives their working conditions; 3) 'effects', how associates are affected by their working environment. There were differences between the working environments of associates working in corporate practice and those in independent practice. They relate primarily to decision-making and finances. While most associates enjoyed their job, a common factor that negatively affected associates was governance including the current NHS contract and actions of the General Dental Council.Discussion The results of this study indicate that associates and the profession face a variety of issues today. The effects this has on associates could contribute to the changes that are being seen in the profession and are explored using social psychology theories.Conclusion The findings of the study complement work demonstrating corporate associates to have lower levels of autonomy than their non-corporate peers and highlights that drivers vary between sectors. Social psychology theories indicate that the working environment could be affecting change in the profession.


Assuntos
Autonomia Profissional , Local de Trabalho , Atitude do Pessoal de Saúde , Tomada de Decisões , Emoções , Pesquisa Qualitativa
13.
Nurs Adm Q ; 43(3): 230-245, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162342

RESUMO

The primary aim of this literature review was to examine the quantity, quality, and consistency of evidence regarding the span of control (SOC) specific to nurse managers. A secondary aim was to meaningfully translate the evidence and offer guidance to 21st-century nurse leaders. The review results were categorized using Donabedian's (2003) Structure-Process-Outcomes model. The Structure-Process-Outcomes approach was used to review the literature and consider SOC recommendations for today's health care environment. Structures outlined the conditions for current SOC, which included material resources, human resources, and organizational characteristics. Processes were defined as activities or actions stemming from identified structures that led to outcomes. Examples included management/administrative activities, as well as frontline staff participation in these tasks. Outcomes were performance measures of human resources, financial, and quality metrics. The review revealed that an SOC model built on a simplistic full-time employment ratio is outdated. Yet, nurse managers remain in their role in the face of these simplistic models despite feelings of inadequacy, exhaustion, and failure because they passionately care about patients and staff. New attitudes and integration of advanced technologies, pioneering tools including SOC assessment tools, and ongoing competency developments will result in different needs of SOC as health care moves deeper into the modern era. This evidence is offered to inform and drive conversations focused on providing optimal nurse manager SOC for maximum effectiveness within unique and ever-evolving care environments.


Assuntos
Liderança , Enfermeiras Administradoras/psicologia , Atitude do Pessoal de Saúde , Humanos , Autonomia Profissional , Local de Trabalho/psicologia , Local de Trabalho/normas
14.
Thorac Surg Clin ; 29(3): 269-277, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31235295

RESUMO

Resident education in the operating room and surgical resident autonomy represent two enormous challenges within cardiothoracic (CT) training programs. The goal of surgical educators and CT trainees is to ensure the graduating resident's ability to safely operate independently at the completion of training. The field has come a long way from the notion of see one, do one, teach one, which was once the norm. Cardiothoracic surgery continues to become more specialized and the patients more complex with greater scrutiny of outcomes. There are many challenges that are faced in contemporary CT training to make intraoperative teaching harder than ever.


Assuntos
Internato e Residência , Cirurgia Torácica/educação , Procedimentos Cirúrgicos Torácicos/educação , Competência Clínica , Medicina Defensiva , Humanos , Internato e Residência/organização & administração , Salas Cirúrgicas , Autonomia Profissional , Fatores de Tempo
15.
BMC Med Educ ; 19(1): 202, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196084

RESUMO

BACKGROUND: A balance between autonomy and supervision can be difficult to obtain in medical education. In this study, we sought to determine whether the presence and level of supervision of ophthalmology resident outpatient clinic correlates with metrics of resident success, professionalism and stress. METHODS: A survey was emailed to all US ophthalmology program directors requesting it be forwarded to PGY4 residents. Questions included whether their program provided a resident-hosted outpatient clinic, and if so, whether residents were mandated to discuss every patient with faculty. Residents were assigned to three categories based on this question (0: no clinic, 1: mandated faculty input, 2: discretionary faculty input). Success metrics included numbers of manuscripts submitted, OKAP scores and success in obtaining fellowships. Professionalism metrics included rating comfort obtaining informed consent, breaking bad news, managing time in clinic, and confidence in providing care in various settings. Residents affirming participation in a continuity clinic also provided perceptions of the level of supervision and how the clinic affected stress. RESULTS: Category 1 residents perceived somewhat too much supervision, while category 2 residents felt that they had somewhat insufficient supervision. The majority of residents in either category did not feel that the continuity clinic affected their overall stress, although those who reported a change in stress usually indicated that the presence of the clinic increased stress. There were no other statistically significant differences between the responses from any category. CONCLUSIONS: The presence of a resident-hosted continuity clinic neither adds nor detracts from the success or sense of professionalism of ophthalmology residents. However, when such a clinic is present, the degree of supervision appears to correlate inversely with resident perception of autonomy. These results suggest that the decision of a training program to offer a clinic hosted by residents offering comprehensive continuity care can be informed primarily by faculty and trainee philosophy and personal preferences without comprising education quality, clinical efficiency, residents' perception of stress or their success in fellowship matching.


Assuntos
Instituições de Assistência Ambulatorial , Internato e Residência/organização & administração , Oftalmologia/educação , Autonomia Profissional , Humanos , Inquéritos e Questionários
16.
BMC Public Health ; 19(1): 758, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200675

RESUMO

BACKGROUND: This study aims to explore the development of job demands, decision authority and social support within and between industries with different gender composition in Sweden between 1991 and 2013. METHODS: Cross-sectional data from 12 waves of the Swedish Work Environment Surveys (1991 to 2013), comprising in total 109,698 respondents, were used. Industries were classified in 7 categories according to its gender composition and main activity, comprising two female-dominated, three gender-mixed and two male-dominated industries. Proportions of workers reporting high job demands, low decision authority and poor social support between 1991 and 2013 were calculated. Logistic regression analyses were performed to estimate variation across time, using 1991 as the reference category, and between industries, using knowledge intensive services as the reference category. Estimates for high job demands, low decision authority and poor social support were presented as average marginal effects (AMEs). RESULTS: The probabilities of reporting low decision authority were higher in education and health and social care during the whole study period, for both genders, compared with the reference category of knowledge intensive services. The probability of having high job demands were higher for men and women in education, and women in health and social care, compared with the reference category. Men in the male dominated industries had increased job demands over time, compared to the beginning of the study period (1991). The probability of reporting poor social support was higher in the later than in the earliest time period for women in the female-dominated industry health and social care as well as in the gender-mixed labour intensive services industry. CONCLUSIONS: There has been a negative development of job demands and decision authority in the female-dominated industries education and health and social care in Sweden, whereas social support has developed more negatively for women in health and social care and in labour intensive services.


Assuntos
Tomada de Decisões , Indústrias/organização & administração , Autonomia Profissional , Apoio Social , Carga de Trabalho/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Suécia , Adulto Jovem
17.
Nurs Leadersh (Tor Ont) ; 32(1): 74-84, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31228346

RESUMO

Feelings of empowerment in nursing staff can contribute to increased job satisfaction, improved quality of care and a higher retention rate within healthcare organizations. Nursing is critical at healthcare organizations, with direct and significant impact on the quality of care provided; yet, nurses often feel undervalued for the work they do. The strength-based approach of appreciative inquiry is one way to engage individuals in finding collective value through the identification of successes, enabling the creation of a shared vision and strategy for the future.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Atitude do Pessoal de Saúde , Hospitais Psiquiátricos/organização & administração , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Satisfação no Emprego , Enfermeiras e Enfermeiros/estatística & dados numéricos , Autonomia Profissional , Enfermagem Psiquiátrica/métodos
18.
Assist Inferm Ric ; 38(2): 66-76, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31241052

RESUMO

. The team-based care models in primary care: General Practitioners' perspectives on nurses' role. INTRODUCTION: In the last decade in Italy, different team-based primary care models have been developed that involve the collaboration of General Practitioners (GPs) with other professionals, such as nurses. AIMS: To investigate the GPs attitude towards the role and levels of autonomy of nurses in the primary care settings. METHODS: A two-phase exploratory study was performed: 1) a focus group with a purposeful sample of 12 GPs was conducted to identify the potential patients-clients/problems and activities that might be assigned to nurses; 2) a questionnaire was developed to analyze the levels of autonomy GPs assigned to nurses for different patients-clients/problems and activities. The questionnaire was administered to a convenience sample of 45 GPs, who were also interviewed to explain their choices. RESULTS: GPs recognized autonomy to nurses in the assessment, monitoring and education on lifestyles, prevention of falls, malnutrition and compliance with treatments; in performing technical and organizational activities. They believed necessary supervision or providing indications to nurses in the management of chronic patients, especially in the assessment of signs and symptoms of deterioration, in monitoring and follow-up and partly on the contents of health education. Finally, GPs felt responsible of the management of pluri-pathological and unstable patients, such as heart failure patients, due to their highly unpredictable and rapid deterioration. CONCLUSIONS: GPs expressed a positive attitude towards the role of nurses in the primary care setting, which varied depending on patients' instability and clinical complexity.


Assuntos
Clínicos Gerais/estatística & dados numéricos , Papel do Profissional de Enfermagem , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Idoso , Atitude do Pessoal de Saúde , Feminino , Grupos Focais , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Autonomia Profissional , Inquéritos e Questionários
19.
J Grad Med Educ ; 11(3): 287-294, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31210859

RESUMO

Background: Research suggests that workplace-based assessment (WBA) tools using entrustment anchors provide more reliable assessments than those using traditional anchors. There is a lack of evidence describing how and why entrustment anchors work. Objective: The purpose of this study is to better understand the experience of residents and faculty with respect to traditional and entrustment anchors. Methods: We used constructivist grounded theory to guide data collection and analysis (March-December 2017) and semistructured interviews to gather reflections on anchors. Phase 1 involved residents and faculty (n = 12) who had only used assessment tools with traditional anchors. Phase 2 involved participants who had used tools with entrustment anchors (n = 10). Data were analyzed iteratively. Results: Participants expressed that the pragmatic language of entrustment anchors made WBA (1) concrete and justifiable; (2) transparent as they explicitly link clinical assessment and learning progress; and (3) align with training outcomes, enabling better feedback. Participants with no prior experience using entrustment anchors outlined contextual concerns regarding their use. Participants with experience described how they addressed these concerns. Participants expressed that entrustment anchors leave a gap in assessment information because they do not provide normative data. Conclusions: Insights from this analysis contribute to a theoretical framework of benefits and challenges related to the adoption of entrustment anchors. This richer understanding of faculty and resident perspectives of entrustment anchors may assist WBA developers in creating more acceptable tools and inform the necessary faculty development initiatives that must accompany the use of these new WBA tools. .


Assuntos
Competência Clínica/normas , Avaliação Educacional/métodos , Docentes de Medicina , Internato e Residência , Canadá , Educação Baseada em Competências/métodos , Educação de Pós-Graduação em Medicina , Avaliação Educacional/normas , Retroalimentação , Teoria Fundamentada , Humanos , Autonomia Profissional , Local de Trabalho
20.
Int J Med Educ ; 10: 113-121, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31203265

RESUMO

Objectives: To interpret the phenomenon of authenticity made visible in medical students' experiences of feeling like a doctor, i.e., how authenticity took shape in narratives about feeling like a doctor in clinical situations where students were challenged to be independent and to a high degree make choices and clinical decisions. Methods: The conducted research was positioned within phenomenological hermeneutic research tradition, interpreting participants' experiences in a life-world perspective using narrative inquiry. Fifteen medical students in their fifth year were interviewed focusing on clinical situations. An abductive analysis approach was used to discover patterns and to interpret data following a phenomenological hermeneutic research method for textual interpretation. Results: The analysis resulted in a thematic structure of findings: Opportunity to experience authenticity through creating relationships; Opportunity to experience authenticity through responsibility; Opportunity to experience authenticity through independence, managing wholeness, and follow-up processes; Opportunity to experience authenticity through being able to reason and discern. Overarching the four themes was the perceived need for attachment, i.e. attachment to patients, to supervisors, to the workplace, to the situation and reasoning and knowledge. Conclusions: Essential for the experience of feeling like a doctor was authentic situations that resulted in the experienced members of a community of practice and the perceived development of a professional identity. These findings can advance the understanding of how clinical education should be organized to facilitate professional identity development.


Assuntos
Educação Médica/métodos , Médicos/psicologia , Profissionalismo , Estudantes de Medicina/psicologia , Adulto , Feminino , Humanos , Masculino , Autonomia Profissional , Adulto Jovem
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